PART 17
Empyema may be recognized in all cases by the following symptoms:
In the first place, the fever does not go off, but is
[p. 53]slight during the day, and increases at night, and copious sweats supervene, there is a desire to cough, and the patients expectorate nothing worth mentioning, the eyes become hollow, the cheeks have red spots on them, the nails of the hands are bent, the fingers are hot especially their extremities,
there are swellings in the feet, they have no desire of food, and
small blisters (phlyctaenae) occur over the body. These symptoms attend
chronic empyemata, and may be much trusted to; and such as are of
short standing are indicated by the same, provided they be accompanied
by those signs which occur at the commencement, and if at the same
time the patient has some difficulty of breathing. Whether they will
break earlier or later may be determined by these symptoms; if there
be pain at the commencement, and if the dyspnoea, cough, and ptyalism
be severe, the rupture may be expected in the course of twenty days
or still earlier; but if the pain be more mild, and all the other
symptoms in proportion, you may expect from these the rupture to be
later; but pain, dyspnoea, and ptyalism, must take place before the
rupture of the abscess. Those patients recover most readily whom the
fever leaves the same day that the abscess bursts,- when they recover
their appetite speedily, and are freed from the thirst,- when the
alvine discharges are small and consistent, the matter white, smooth,
uniform in color, and free of phlegm, and if brought up without pain
or strong coughing. Those die whom the fever does not leave, or when
appearing to leave them it returns with an exacerbation; when they
have thirst, but no desire of food, and there are watery discharges
from the bowels; when the expectoration is green or livid, or pituitous
and frothy; if all these occur they die, but if certain of these symptoms
supervene, and others not, some patients die and some recover, after
a long interval. But from all the symptoms taken together one should
form a judgment, and so in all other cases.
